Parathyroid Sestamibi (Technetium 99m) Scanshowing right inferior parathyroid adenoma
Right inferior parathyroid adenoma.
The use of a parathyroid scan and the Neoprobe allow fast localization of the tumor and its removal through a small incision, without having to explore the other three parathyroids. This is called minimally invasive radioguided parathyroidectomy (MIRP).
Neoprobe Neo2000 Apparatus
A high radioactivity count is obtained when the hand-held probe is placed over the tumor. When the tumor is removed, the radioactivity level drops down to background levels, while the removed specimen remains hot.
1. The patient is injected intravenously with a small protein called sestamibi which is labeled with a radiopharmaceutical called Technetium-99m. The injected tracer will circulate within the patient's bloodstream, eventually localizing in one or more overactive parathyroid glands.
2. The patient is taken to the operating room within a two to three hour time frame, and the surgeon uses the gamma detection probe to localize the overactive, radioactive gland(s).
The parathyroid glands are four small glands involved in the metabolism of the body's blood calcium. They are located around the thyroid gland in the neck.
Blood and urine tests detect abnormally functioning parathyroid glands (usually finding a high level of calcium). In a new technique, patients with suspected parathyroid adenoma are injected with a radioactive substance (technetium 99m-labeled sestamibi). Tech99m-sestamibi is a commercially available imaging agent used mainly for heart imaging. This substance has been found to also concentrate in abnormal parathyroid tissue.
After an appropriate amount of time, a surgeon will use the Neoprobe® 1500 Portable Radioisotope Detector outside the body in the neck area to find the localization of radioactivity which indicates the location of the abnormal parathyroid tissue. During surgery, the physician will make a smaller incision and expose the parathyroid tissue. The probe is then inserted intraoperatively to confirm the area of radioactive concentration which coincides with the enlarged, abnormally functioning parathyroid gland.
This procedure helps the surgeon locate these abnormal glands which are hard to find because their location is variable. They are also very small and are similar in color to the nearby thyroid gland. The benefits to the patient include use of local anesthesia, smaller incisions, reduced surgical times, reduced complication rates, same day surgery and reduced expense vs. traditional surgery.